Which medications in the drug class Selective norepinephrine reuptake inhibitors (SNRIs) are used in the treatment of Pediatric Attention Deficit Hyperactivity Disorder (ADHD)?

Updated: Nov 20, 2018
  • Author: Maggie A Wilkes, MD; Chief Editor: Caroly Pataki, MD  more...
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Selective norepinephrine reuptake inhibitors (SNRIs)

These are nonstimulant ADHD (ADD) medications generally used as adjuncts to stimulants.

Atomoxetine (Strattera)

SNRI that inhibits presynaptic norepinephrine transporter. Also appears to indirectly stimulant dopamine activity in frontal lobes. Many anecdotal reports state that, when stimulants are not well-tolerated at a dose necessary for efficacy (eg, because of anxiety) and atomoxetine is not efficacious enough alone, the combination of atomoxetine and low dose (tolerable) stimulants is often very effective.

About 5-10% of patients are poor metabolizers of the drug and have increased drug exposure, peak serum levels, and half-lives. If intolerable but benign adverse effects are present at FDA-recommended doses, but not at lower dose, efficacy may be observed at the lower dose; therefore consider a low-dose trial. Usually clinically effective qd despite 5-h half-life (24 h in poor metabolizers); unknown if serum levels are correlated with efficacy.

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